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S 0769 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPE WTINO HOILDINC,-ELECTRICAL. PIsuMTr No. BUILDING DIVISION APPLICATION/PERMIT I'LlIM111tINC.-M111?CHANIGU. ItI111.D1;VG PR(/JF1GT LUENTIFICAiION SANITARY NO. APPLICATION SUtlMI'ITAI.DA IIILDING ADDRESS: _ �© �.8I�� �lLC9�7 SE NAME. P}{0 E ^ CONTRACTOR'S NAME: �� LIC NO: �r� ry/C CONTROLp 4ARCHITECHENGINECR: op LIC ADDRES.. BUILDING PERMIT INFO CONTACT: . ) ❑ Consultant Fees Paid by Applicant(Initial) HLDG ELECT' PLUMB MECH _ _ ❑ 1 El EJ LICHNSEDCON AAS DF.CLARATIO� QTY ELECTRIC PERMIT FEE JO13 DESCRIPTION hereby uHinn Thal I On licensed under provisions Of Chapter 9(amtmencing �fgZ with Section)m11BofDivision lofbhe Busine,and Prid timsCrde.and my license is RESIDENTIAL: PIiRMI I'ISSUANCE m p full force and effect.. ❑SPDW'I, ❑KITCHIiN R13M(IOIiI. C-F- <—U License Class Lia.N APPLIANCES-RESIDENTIAL ❑AUDITION ❑PLUMBING RE-PIPE i,zw Lac C...rocnr � ❑MUETI.DNH' ❑STRUC'I'DEAL ARCHITECT'S DECLARATION I'ANIa,S MODIFICATION zOy� lunderdund lay plunx shall be u,ced u%publlc ru'arJ% l UI"IU21111AMP5 OZ�Q - ❑IN'I HRIOR ❑CHIMNEY REPAIR �F'2Lw LTrenwol Professional 201-Imx)AMl6' IMPROVEMENT 0SWIMMINC POOLS OWNER-HUILDER DECLARATION aViiH lmxlAMlS ❑BA'1'll kliMOUIiVRIiPAIR ❑DEMQhI'1']ON a C 1 hcrchy nation IhW 1 nln exempt Boor the Contractor's License law lin nc Any city Y SIGNS IILECI RACAL ❑(TIMER 3 W F following reumn.Section"lolls.Business and Professions Cale:An t chum - which mantles a permit to canswcl,alter,improve,demolish,or repair any suuaure NQ.1 prior to its issuance,also require%the applicant for such proud to file a.signed aeenent SPECIAL CIRCU UUMISC. that he is licensed personal to the pro kions of the Conadclor's License Law(Chapter e COMMERCIAL (commencing with Section 7000)of Division 3 of the Business and Professions Cdel or 'I'rhfl'.MID'IiR OR POLE(NST d d C that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NI?W BLDG/ADDITION ❑DEMOLITION DoH Scotian 703 is by any applicant for a permit subjects the apirlicamtw evil pc..try of POWER DEVICES ❑TENANT ❑FOOD SERVICE m more than five hundred dolls,1550% IMPROVEMENT =C Flt.as Owner of the pnrpery,or any employees with wages as their sole compensation. SWIMMING POOL ELECTRIC - ❑0HIER F will do the work,and thestmaurt i%om intendedaroRere!forsale(Sec.7tW,Business W 3 m and Professions Code:The ContractorET s License law does not apply,to an owner of OUTLS-SWITCHES-FIXTURES property who builds or improves thereon.and who does such work himself or through NEW RESIDENTIAL.ELECItt SQ FT. his awn employees,provided that such impmvemems are not intended or offered for SQ.W.FLOOR AREA $/SQ ET sale.If,however.the building or improvement i%sold within one yeatof completion,the oncincir-builder will have the burden of proving that he did not Wild or improve for pur- mrseofsulcJ. - TO'T'AL: 1,us owner of the prnpcny,am csclmively contracting with licensed contractors Ir instruct he pnrjeO(Sea NUq.Bminee%nnd Mofe ion%Code:)qua Contmanf'n li- P p ' t sense Law dewm s aapply to on Owner of propery who builds or re improves theon.and QTY. PLUMBING PERMIT FEE M s whocontmcls for such projects withacontrucardq licensed ptsevnuothe Conwemr's I� License Law. PERMI IISSUANCE g pl nmexenpltmde Sce ,B&PCI nhisrtwnn Y AI:HFR-DRAIN ak V HN'T-WATER(EA) M&kjfAl'ION Owner - - Data - V WORK17R'S COMYENSATON DECLARATION RACK FLOW PROTECT..DEVICE ` �/- LUr� r - I hereby affirm underpenallyof perjuryoneofthe billowingdealarationa. I have and will mxinmi n a Cori Beam of Consent to self-invure for Worker x Comfort DRAINS-IT.00R,ROOT',AREA,COND. STORIES TYPE CONSTHUCI'H arbon,as provided vided Inr ny Sermon 3TIN1 of the Lvhnr Cede.for the performance of the - work liar which this pennil is isweJ. VIVIURES-PHR THAI' Fj I have and will maintain Worker's Compensation Insurance,as required by Section 370U of the laMe circle,for the parriance ofthe work for which this permit is issued, GAS-EA.SYSTEM-I INC.JOUTLETS OCC.GROUP APN a My Weaker x Compemminn lnsumnce carrierand Policy number are: GAS-HA.SYSTENLOVER 4(EA) Carrier: Policy No.: CERI'IRCATE OF EKIiht PI30N FROM WORKERS' COMPENSATION INSURANCE GREASIVINDUSTRI.WASTE INTERCEPTOR BUILDING DIVISION FEES (This section need and M eompldN ifthe permit is for an hundred dollars IS big)) GREASE'IRAP - PLANCHECK Bili tole .l Toy anythat in the pcdocrame of he wed for which this ficarthe at is Workers C, pen-hall SIiN'ER-SANITARY-STORM F.A.200 FT. ..NIiRGY Prr; n h employ any librn in any manse99 hoc n' t m the Woden'Cnmpen- setinn law%ogC;tl`min.Dula WATER wAT1iR HIiATER W/VF.Nr/ELECTR licvm '-YY GRADING FEE 'z'rA NOTICE. R) A T:IC a ter nmk'Inbb �Eci re of Esempeon.You mould W'A'1'IiR SYS'1'IiA1/1'REATING SOILS FEE a bosons%abject to the Wader's Compensation pmvrslnns Or the Lalen Crdeyou utast Jorm ithunnply wish such provisions nr this permit shall rte ccemenrevoked.. WArER SERVICE 0.� CONS'TRUCT'ION LENDING AGENCY NHWRESIDENIIALPI.M. SQ.EL (AID z _ Date RueiplN I hereby affirm(hut Iheru is a eanxWefmn lending agency far the perlimnuna nr G - Inc work for whicbdri%Iwrmil is iswoil(See 1897.Co,C) TOTAL: C) Land<e,Nit a TO9'nL: U Lennon Address 11CILDIN .FEE CYl I certlly that I have read his application and state that the move information Is t: rq creno.I agree ,,comply win all city and county ordmunces and emtc laws rcluling ,, QTY. MECHANICAL PERMIT FEE SEISMIC FEE U nudiingcnouraclion,and hereby amhnsiia representatives stints city toemter upon the above mentioned properly tor Inspenlon purryrses, I'IiRh11T ISSUANCE 171.1iC1'RIC Bili (We)agree to save,indemnify and keep harmless the Cay of Cupenion again% Iiabililics,judgmcros,costs and expenses which may in any wvyaccmc agent said City' ALTER OR ADD'fO MECH. PLUMBING THE in consequence Of the Gtrading of this Permit, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNITOO IB,IXIJCFM) MECHANICAL Fra[ SOURCEREGUL ' ONS. AIR HANDLING UNIT(OVER E."CFM) CONS'TRUCfION TA% tri Sig reo pplicanVConwngr Dv EXHAUST GOOD IW/DUCfJ HOUSING MITIGATION FEE "CiGAP.AR000S ERIALS DISCLOSURE Will the applicant nr future ding rrecupanl sm¢orhandle hazalloux material HEATING UNIT(TO 100.000 BTU) as dorZ by the Cupertino Mu cipel Cade.Chair 9.IZ and the Ifeabn and Safety IIIiA'I'ING UNIT(OVER[00.000 BTU) Cade.SeOion 25532mr? ❑Yes ON. gH 4CONDITIONER ON PAN(SINGLE RESID) PAID Dam koeeipt p Will the applicant or future building Occupant use equipment or devices whichOMP(111P OR It1B.(NIB BTU( emit haunon,sir aommnumnts as defined by the Bay Arca Air Quality Management TOTAL: District f BOILEROMP(OVF,R IN)000 BTU) 6 pre% 0 N ISSUANCE UAT'E . l lows rcvd the ri'r.anlna%anterial,requires an,,under Chaplcr M1.95 111'he Culi- Iomih Health k Safcby Cole Sections 2550.5,25533 and 255411 und...land that it the N'FIN-MECH. SO FT. building dors 11,11 ctmmuly Teva a local,that II it my resryesibibiy nr ta'til'y rte arnpmv of the requirement,which era%(he met prior to r,a taee Of.Cenuiene Of(x<apuncy. Owner nr vmMrriseJ ngcnl Dale TOTAL ISSUIiU BY: OFFICE